Provider First Line Business Practice Location Address:
2815 ELLSWORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94705-1021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-272-9278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2021